fandarast
Forum Junior
Topics: 15
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A 28-year-old woman, gravida 1, para 0, comes to the outpatient prenatal clinic at 34 weeks' gestation with a twin pregnancy. Her fundal height is 40 cm and the orientation of the fetuses in the uterus is cephalic-breech presentation. She has had intermittent watery vaginal discharge for the past few days. she has had to wear a perineal pad for comfort. She denies dysuria or burning but admits to urainary frequency. Which of the following is the most appropriate next step in the management of this patient?
A. Nitrazine paper on the perineum
B. Speculum examniation for vaginal pooling
C. Sonogram for amniotic fluid volume
D. Urinalysis for urinary tract infection
E. Digital examination for cervical dilation
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| jasmin
Forum Junior
Topics: 7
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bnext c
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| jasmin
Forum Junior
Topics: 7
Posts: 40
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sorry
b next a
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| simi
Forum Elite
Topics: 53
Posts: 357
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yes b next a
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| fandarast
Forum Junior
Topics: 15
Posts: 53
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The correct answer is B.
The clinical scenario strongly suggests PROM. Accurate assessment of PROM is essential because the outcome of pregnancy can be adversely impacted by a posible diagnosis. This question addresses confirmation of PROM by examination, rather than with history data. A speculum examination is helpful in determining the extent of vaginal pooling. Nitrazine paper on the perineum and sonographic oligohydramnios have low specificity and sensitivity for ruptured membranes. Urinalysis is is not relevant. Digital examination should never be done until membrane rupture is ruled out because of the increase in infectious morbidity.
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